Maastricht UMC+
Assessment
In order to process your application, we require the following information. Your referring physician can send this information either via a secure online connection or by post:
- Patient’s name, address, town/city of residence and date of birth;
- A CT scan (thorax and abdomen) in DICOM setting (CTA scan with 1-2 mm intervals) not older than six months; and
- Medical data to establish the patient’s cardiac and pulmonary condition, which may include a lung capacity measurement, coronary angiography and ultrasound of the heart.
Once the above information has been collected, your case will be discussed during the weekly Multidisciplinary Aorta meeting. The findings of this meeting will be used to draw up the official diagnosis and TAAA treatment plan. The aortic surgeon will then relay the plan back to your referring physician, who will discuss it with you.
Applying for the procedure
If you agree to the proposed TAAA treatment, the International Patient Office will send you a cost estimate and the medical file that you need in order to submit an application to your health insurer (often an E112 or S2 form). Forms can be requested from your health insurer. If the National Health Board is responsible, you will need to ask them for the relevant forms.
Pre-operative screening
Your case manager will then draw up a pre-operative screening plan. This pre-operative risk assessment will take place partly in your own hospital. Your case manager will request the following tests from your referring physician: coronary CT, echo cardiography, lung capacity measurement and blood tests. As soon as these results are in our office, the aortic surgeon will assess whether the risk of surgery is acceptable and whether open or endovascular repair is the best option for you. Your case manager will communicate the risk assessment to you, and the referring physician will receive a written copy from our aortic team.
You and your referring physician will make the final decision regarding treatment at the Maastricht Heart+Vascular Center.
If you agreed to the proposed TAAA treatment, you will inform your case manager and confirm your decision either by transferring the deposit amount, or forwarding your health insurer’s guarantee statement to the International Patient Office (heartandvascularcenter@mumc.nl).
Once the above has been received, your case manager will schedule your additional screening and your treatment, and inform you either by e-mail or post. If desired, our hospitality officer at the International Patient Office can arrange travel, accommodation, visa or interpreting services for you. Simply tell your case manager what you would like.
Pre-operative screening at MUMC+
A number of pre-operative tests will be carried out three days before your operation. They will be performed in outpatient setting. This means that you will NOT be admitted to the Maastricht Heart+Vascular Center. During these tests, you will stay at the accommodation of your choice and at your own expense, that you can either book yourself or have us book for you. During your first appointment, your case manager will welcome you and any attendants at the Maastricht Heart+Vascular Center outpatient clinic.
The next few appointments will be with your aortic surgeon, who will explain the operation and potential complications (read more about complications here). You will also have an appointment with a cardiologist and an anesthetist, who will both assess whether your condition is acceptable to undergo the operation. Lastly, if some data is missing, some blood and performance tests will be carried out including lung function tests and an ultrasound of the heart (echocardiogram).
Admission and operation
You will be admitted one day before the operation. Your case manager will tell you where you need to be. In the hospital ward, responsibility for your care will be transferred from the case manager to the medical and nursing team (however, the case manager will remain your primary contact person). The aortic surgeon will see you once more, and you can ask any remaining questions you may have. You will also have the opportunity to visit the intensive care unit (ICU) with one of the nursing staff, as this is where you temporarily will be staying after your operation. All guidelines for taking medication and fasting will be explained to you once you are in the hospital.
On the day of the operation, the nursing team will take you to the operation area and give you all the information you require. The multidisciplinary team, led by the aortic surgeon, will take around 4-8 hours to perform the operation, depending on the complexity and whether it is an open or endovascular procedure. Afterwards, you will be taken to the ICU. The nursing and medical teams at the ICU will provide your attendants with information for the first few days after your operation.
You will not be able to breath your self during the first day(s) following the operation. Therefore you will be supported by a respiratory machine. The tube is usually inserted into your trachea (windpipe) through the mouth. You will also temporarily require multiple IV drips, a chest tube (in the case of an open repair), a catheter in the spinal cord and a urinary catheter to support you during the initial post-operative recovery.
If your condition is sufficiently stable (your heart and lung function must be stable, among other things) and there are no complications requiring you to stay at the ICU, you will be taken back to the normal ward. You must understand that if there are complications, you will stay in the ICU for as long as necessary.
Medical and nursing care in the hospital ward is aimed at rehabilitation and reactivation. During your first few days there, you will certainly need maximum support in terms of physical care, dressing wounds and mobilisation (physiotherapy), all aimed at a speedy recovery.
Discharge and aftercare
Two to three days before you are discharged, it will become clear that you have sufficiently recovered to make the trip home. If you like, our hospitality officer can arrange for your return travel. Your case manager will coordinate your request. When you are discharged, your medical and nursing team will issue you with a treatment report. It will also be sent to your referring physician, and agreements made with them regarding your aftercare and check-ups. These will take place in your local hospital, and will include an assessment of the post-operative CT scans. Your own doctor will do this, and any abnormalities will be discussed by the MUMC+ aorta team.
Two weeks after your discharge, we will be able to draw up a final account. This may differ from the initial quote, which only included an estimate of your stay in intensive care. Complications can lengthen this time, resulting in higher costs and differences on the final account. If your stay in ICU is shorter, then the account will of course be lower.